Reviews of Educational Material  |   September 2009
A Practical Approach to Regional Anesthesia, 4th Edition.
Author Notes
  • University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Article Information
Reviews of Educational Material / Regional Anesthesia
Reviews of Educational Material   |   September 2009
A Practical Approach to Regional Anesthesia, 4th Edition.
Anesthesiology 9 2009, Vol.111, 684. doi:
Anesthesiology 9 2009, Vol.111, 684. doi:
A Practical Approach to Regional Anesthesia, 4th Edition.  By Michael F. Mulroy, M.D., Christopher M. Bernards, M.D., Susan B. McDonald, M.D., and Francis V. Salinas, M.D. Philadelphia, Lippincott Williams & Wilkins, 2009. Pages: 356. Price: $85.00.
This book is not a traditional textbook that contains considerable detail; rather it is more of a hands-on book intended to provide the practical essentials of regional anesthesia blocks performed in the Virginia Mason Medical Center, Seattle, Washington. The first edition appeared in 1996. This is the fourth edition, which reveals that it has been repeatedly updated to include the rapid development of the practice of regional anesthesia. For example, this edition includes new sections on ultrasound-guided regional anesthesia and the use of peripheral nerve catheters. Both are essential, because they represent very important advances in the practice of regional anesthesia and improve its safety and reliability.
I believe that the authors have covered these new advances fairly well in this book, especially in their descriptions of equipment and a variety of regional blocks including the brachial plexus, peripheral nerves of the upper extremity, lumbar plexus, and sacral plexus-sciatic nerves. In comparison to the third edition, this edition has more authors (four authors and one contributor) who have added strength to this book, while the third edition had only one author and two contributors. That 2002 edition had 24 chapters, while this edition has only 23 chapters. In this latest edition, the chronic pain management and obstetrical anesthesia chapters have been removed. A new chapter on the use of regional anesthesia for ambulatory surgery has been added. The 2002 edition had 113 figures and 23 tables, while the 2009 edition has 145 figures and the same number of tables. There is a significant increase in the number of comprehensive figures, diagrams, schemes, and photographs illustrated in the different chapters. These facilitate the reader’s understanding and provide a more pleasant reading experience. A further enhancement is the use of color in figures and tables in this new edition.
The book’s first two chapters, Local Anesthetics and Local Anesthetic Clinical Pharmacology, are excellent. The author covers updated local anesthetics pharmacology in a very concise and effective manner. The chapters reviewing complications of regional anesthesia, premedication, and monitoring provide concise and updated ideas relevant to clinical practice, allowing readers to master the essentials of these topics.
The chapters dealing with spinal, epidural, and caudal anesthesia are very informative, well written, and updated with recent references. These chapters also include very good illustrations and images. The intercostal and terminal nerve anesthesia of the trunk and the paravertebral chapters were updated in this edition with more references and multiple figures, including advanced ultrasound-guided blocks images. The airway, cervical plexus blocks, ophthalmic anesthesia, pediatric regional anesthesia, ambulatory surgery and postoperative pain management chapters were written in a concise and very informative manner.
The block choices and descriptions are supplemented by excellent illustrations as well as photographs of ultrasound guidance, anatomy, surface anatomy, and needle positions. One of my favorite chapters that showed the authors’ experience described anesthesia of the brachial plexus. In the chapters on peripheral nerve blocks of the upper extremity, lumbar plexus blocks, and sacral plexus–sciatic nerve blocks, the authors did a great job of incorporating recent advances in using ultrasound guidance and insertion of catheters. However, they omitted other techniques for performing these blocks, mentioning them only as references. The authors only discussed the use of an in-plane transverse middle scalene approach. These narrowed discussions led me to conclude that the text might be better titled as the Virginia Mason Manual of Regional Anesthesia Techniques.
One of the difficulties of rewriting new editions of a textbook is the need to include new and important references. In this case, however, I could not find any important omissions. The book is comprehensive and refreshingly uniform and nonrepetitive. In conclusion, this book is worthy to be included in the library of all anesthesiology departments, especially to support the education of trainee anesthesiologists.
University of Arkansas for Medical Sciences, Little Rock, Arkansas.